目的：探讨CT检查在肝脏包虫病诊断中的价值,并进行误诊分析。方法：收集经病理证实的18例肝脏包虫病病例,并以术后病理结果为金标准,回顾分析患者的CT影像特点,并评估CT检查诊断肝脏包虫病的价值。结果：18例肝脏包虫病患者中,经CT检查准确诊断者为14例,CT诊断准确率为77.8%,另4例患者分别被误诊为肝囊肿2例,血管瘤1例,肝癌1例。肝细粒棘球蚴病患者为17例,其中单纯囊肿型9例,CT图像上表现为肝内囊性低密度灶,单发或多发,呈圆形或类圆形,其中2例可见囊壁弧形或蛋壳样钙化,长短、厚薄不一;1例囊内钙化,CT图像上表现为类圆形或球形钙化灶;1例为多发钙化,既可见囊壁钙化型,也可见球形钙化灶型;含子囊型6例,表现为囊中囊、轮状或蜂窝状改变;混合型1例,可见钙化型病灶及含子囊型病灶。合并感染后,患者的CT表现为囊内密度增高,囊壁增厚。肝泡状棘球蚴病患者1例,CT平扫表现为密度不均匀,边界模糊的斑片低密度影,并伴肺播散,该例CT表现为肝内病灶范围广泛、两肺多发类似病灶,被误诊为原发性肝癌伴两肺转移。另有2例患者的CT表现为病灶单发囊性病灶,无囊壁,增强CT图像上未见强化,被误诊为肝囊肿;1例患者的CT表现可见球形钙化,被误诊为硬化性血管瘤。结论：CT检查能准确显示肝包虫病的类型、发生部位、范围和程度,但表现为单纯囊肿型时,需要与肝囊肿鉴别;肝泡状棘球蚴病的影像学表现复杂,需与原发性肝癌鉴别。
Objective: To explore the value of CT for diagnosing hepatic hydatidosis. Methods: A total of 18 cases with pathologically confirmed hepatic hydatidosis were enrolled, and CT features were retrospectively analyzed with the pathological findings served as gold standard. Results: Of the 18 cases, 14 cases were diagnosed as hepatic hydatidosis by CT preoperatively, with an accuracy rate of 77.8%, while 2 cases were misdiagnosed as hepatic cyst, 1 case as liver carcinoma, and 1 case as hepatic hemangioma. For the 17 cases with cystic echinococcosis, 9 cases were of simple cystic type, lesions on CT imaging were presented as single or multiple low density foci, cyst wall arc or eggshell like calcification; 6 cases had echinococcus hydatid sac in cysts with changes of wheeled or honeycomb, and might presented as mixtures of lesions. CT imaging revealed that cystic wall was thicker and cystic density increased when there was infection. The one case of alveolar echinococcosis was misdiagnosed as liver carcinoma, with a wide range of lesions in liver and spread of lesion to bilateral lung on CT imaging. Two cases with single cyst were misdiagnosed as hepatic cyst because CT showed no cyst wall and without obvious contrast enhancement. Conclusions: CT scan can clearly reveal the location, size, number and type of hepatic echinococcosis, which could provide valuable information for diagnosis. Differential diagnosis should be made between hepatic echinococcosis and hepatic cyst when lesions present as simple cysts on CT imaging. CT findings of alveolar echinococcosis are complicated, and should be differentiated from those of liver cancer.
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